Hepatocellular carcinoma surveillance: An evidence-based approach

Table 1 Patients at the highest risk for hepatocellular carcinoma

Population group	Threshold incidence for efficacy of surveillance (> 0.25 LYG; % per year)	Incidence of HCC (% per year)
High risk of HCC for whom surveillance benefit is indicated
Asian male hepatitis B carriers over age 40	0.2	0.4%-0.6% per year
Asian female hepatitis B carriers over age 50	0.2	0.3%-0.6% per year
Hepatitis B carrier with family history of HCC	0.2	Increased
African and/or North American blacks with hepatitis B	0.2	HCC occurs at a younger age
Hepatitis B carriers with cirrhosis	0.2-1.5	3%-8% per year
Hepatitis C cirrhosis	1.5	3%-5% per year
Stage 4 PBC	1.5	3%-5% per year
Genetic hemochromatosis and cirrhosis	1.5	Probably > 1.5% per year
Alpha-1 antitrypsin deficiency and cirrhosis	1.5	Probably > 1.5% per year
Cirrhosis secondary to other etiologies	1.5	Unknown
High risk of HCC for whom surveillance benefit is uncertain
Male hepatitis B carriers younger than 40	0.2	< 0.2% per year
Female hepatitis B carriers younger than 50	0.2	< 0.2% per year
Hepatitis C and stage 3 fibrosis	1.5	< 1.5% per year
NAFLD without cirrhosis	1.5	< 1.5% per year

Adapted with permission from AASLD guidelines on management of HCC[7] and HCC Surveillance[62]. LYG: Life-years gained; AASLD: American Association for the Study of Liver Disease; HCC: Hepatocellular carcinoma; NAFLD: Non-alcoholic fatty liver disease.